神经阻滞治疗带状疱疹

带状疱疹临床较常见,是疱疹病毒感染同时累及神经皮肤的疾病,中医称“缠腰蛇”。该病具有剧痛与感染的特点,病人较痛苦。以往皮肤科主要用于抗疱疾病毒药物治疗,疗程长,疗效差。我院从1993年开始对138例采用药物治疗同时配合神经根阻滞疗法综合治疗,取得满意的疗效。现报告如下。     

联合神经阻滞麻醉在髋关节置换术中的应用

髋关节置换手术一般可于传统的全麻、椎管内阻滞麻醉下完成手术.但少数患有严重的心肺疾病、高龄脊柱病理骨折等问题,不适于椎管内阻滞或椎管内穿刺失败,如何解决此类患者手术的麻醉,给临床麻醉提出了新的课题.我院2010年以来开展下肢腰丛、坐骨神经、L1 ～ L2椎旁神经联合阻滞麻醉,有效地解决了这一问题,取得了满意的效果,报告如下.     

臂神经丛联合阻滞的应用

目的总结＂四针法＂臂丛神经联合阻滞的经验,指导神经刺激仪的合理应用。方法回顾性分析臂神经丛阻滞356例,根据阻滞方法分为联合组（n=148）,联合组同时实施肌间沟阻滞加腋路阻滞加肋间臂神经阻滞;传统组（n=208）,传统组只实施肌间沟阻滞（n=176）,或腋路阻滞（n=32）,不行肋间臂神经阻滞。结果联合组麻醉效果优占97.3%,穿刺异感占47.3%;传统组优占87.0%,穿刺异感占69.7%。联合组与传统组比较,具有显著差异（P〈0.01）。结论 ＂四针法＂臂神经丛联合阻滞可提高臂神经丛阻滞的成功率。     

肩胛上神经和腋神经联合阻滞治疗肩周炎的应用解剖

目的：为神经阻滞治疗肩周炎提供解剖学基础。方法：在３４侧经常规防腐处理的成人尸体标本上解剖出肩胛上神经和腋神经,观察其走行位置及分支分布,拟定穿刺点及体表定位。结果：①肩胛上神经主要分支有冈上肌支和冈下肌支。肩胛上神经在肩胛横韧带处距皮肤的距离和冈上肌支起始段距皮肤的距离均为４．０～４．５ｃｍ,冈下肌支起始段距皮肤的距离为４．０ｃｍ。②腋神经主要分支有前支和后支。腋神经穿四边孔处距皮肤的距离为５．     

牙神经阻滞的解剖学基础

目的:观察三叉神经及其分支的走行路线,探讨牙神经阻滞的解剖学依据.方法:对10具成人尸体标本,按照常规解剖方法观察三叉神经及其分支的走行路线,并据此分析神经阻滞的体表定位和操作可行性.结果:三叉神经走行路线清晰,与牙的关系密切.神经阻滞定位准确,操作具有可行性.结论;三叉神经阻滞在治疗牙痛等牙齿疾病方面切实可行.     

肩胛上神经阻滞治疗肩周炎的应用解剖

目的：为肩胛上神经阻滞治疗肩周炎提供形态学依据。方法：在34例经常规固定的成人尸体标本上部剖观测了肩胛上神经及其分支的走行及分布,拟定了穿刺点及其体表定位方法,并进行募拟穿刺。结果：肩胛上神经起于臂上干,斜向后外下径斜方肌深面及肩胛切迹至网上窝。起干臂丛上干处的外径为1.86±0.25mm,干长为43.0±6.0mm。主要分支有冈上肌支,冈下肌支及较为细小的肩关节支。冈上肌支外径为0.08±0.12mm,干长为26.6±3.9mm;冈下肌支的外径为1.07±0.13mm,干长为41.5±5.7mm。结论：根据肩胛上神经恒定的走行和分支分布,对其定位阻滞可作为治疗肩周炎的一种有效方法。     

超声引导下前锯肌神经阻滞复合腹直肌鞘神经阻滞在肝癌手术中的应用价值

目的:分析超声引导下前锯肌神经阻滞复合腹直肌鞘神经阻滞在肝癌手术中的应用价值.方法:选取本院2019年8月至2021年5月收治的102例进行择期肝癌开腹手术患者作为研究对象.根据不同治疗方法分为对照组(n=49)与研究组(n=53).对照组采用静吸复合全身麻醉,研究组在对照组的基础上采用超声引导下前锯肌神经阻滞复合腹直...     

超声引导技术在肌间沟臂丛神经两点阻滞中的应用

目的比较超声引导定位法与神经刺激器引导定位法用于肌间沟臂丛神经阻滞的效果。方法拟行上肢手术的患者90例随机分为3组(n=30),对照组:神经刺激器定位单点阻滞组;US组:超声引导与神经刺激器确认相结合定位单点阻滞组;UD组:超声引导与神经刺激器确认相结合定位两点阻滞组。各组均给予0.5%的罗哌卡因30 mL,其中UD组被阻滞的两支目标神经各给予15 mL。结果UD组阻滞平均起效的时间明显短于US组和对照组。UD组感觉神经阻滞完善率明显高于US组和对照组。结论超声引导下行肌间沟臂丛神经阻滞起效快,并发症少;超声引导下两点阻滞法可明显改善阻滞效果。     

双重引导锁骨上臂丛神经阻滞在肘部手术中的应用研究

目的 探析应用超声联合神经刺激仪辅助进行锁骨上臂丛神经阻滞麻醉在肘关节区手术中的应用效果。方法 选择2016年12月~2018年7月我院60例行肘关节区手术的患者,随机分为常规组和联合组,各30例,常规组应用神经刺激仪辅助麻醉,联合组在此基础上联合超声引导辅助麻醉;比较两组麻醉起效时间、镇痛效果、不良反应发生率及阻滞失败率。结果 联合组麻醉起效时间短于常规组,差异有统计学意义（P＜0.05）;两组麻醉操作时间、麻醉持续时间比较,差异无统计学意义（P＞0.05）;联合组镇痛效果优良率为100.00%,高于常规组的86.67%,差异有统计学意义（P＜0.05）;联合组不良反应发生率、阻滞失败率均低于常规组,差异有统计学意义（P＜0.05）。结论 超声联合神经刺激仪辅助进行锁骨上臂丛神经阻滞可有效缩短麻醉起效时间,提高麻醉效果,镇痛效果良好,安全性高。     

Needle stylet with integrated optical fibers for spectroscopic contrast during peripheral nerve blocks

The effectiveness of peripheral nerve blocks is highly dependent on the accuracy at which the needle tip is navigated to the target injection site. Even when electrical stimulation is utilized in combination with ultrasound guidance, determining the proximity of the needle tip to the target region close to the nerve can be challenging. Optical reflectance spectroscopy could provide additional information about tissues that is complementary to these navigation methods. We demonstrate a novel needle stylet for acquiring spectra from tissue at the tip of a commercial 20-gauge needle. The stylet has integrated optical fibers that deliver broadband light to tissue and receive scattered light. Two spectrometers resolve the light that is received from tissue across the wavelength range of 500-1600 nm. In our pilot study, measurements are acquired from a postmortem dissection of the brachial plexus of a swine. Clear differences are observed between spectra acquired from nerves and those acquired from adjacent tissue structures. We conclude that spectra acquired with the stylet have the potential to increase the accuracy with which peripheral nerve blocks are performed.     

组织工程在周围神经缺损修复中的应用

近年来组织工程学的迅速发展使其在周围神经修复方面有了，“阔的发展空间。组织工程的核心是建立细胞与生物材料的三维空间复合体，即具有生命力的活体组织，用以对病损组织进行形态、结构和功能的重建并达到永久性替代。其重点问题包括：导管材料的选择以及神经生长的微环境。     

Dimethylsulfoxide (DMSO) blocks conduction in peripheral nerve C fibers: a possible mechanism of analgesia

Dimethylsulfoxide (DMSO) is readily absorbed through skin, and relieves musculoskeletal pain when applied topically to painful areas. We studied the effects of DMSO on C-type nerve fibers, which mediate pain sensation. DMSO was applied directly to exposed cat sural nerves. C fiber conduction velocity was slowed by DMSO, even in low concentrations (5–7% v/v). Higher concentrations completely blocked C fiber conduction, with a minimum blocking concentration of 9%. Onset of nerve block was almost immediate with 15% DMSO or higher concentrations. C fiber blockade may account for analgesia with DMSO.     

壳聚糖神经导管联合施万细胞桥接修复周围神经缺损新进展

正壳聚糖(Chistosan,CS)是一种生物相容性良好,可降解且无毒性的生物材料,其具有促进神经生长因子分泌的特点,同时发挥广泛的抗菌、抗炎、止血、止痛作用。壳聚糖及其衍生物可用于神经损伤的修复,以及作为神经支架,联合各种生长因子、种子细胞等桥接神经缺损。施万细胞(Schwann cells,SCs)是周围神经系统的主要胶质细胞,具有多种生理功能,当周围神经受损时,可为轴突再生提供通道,可分泌数种神经营     

Epithelial membrane antigen expression by the perineurium of peripheral nerve and in peripheral nerve tumours

Specimens of normal peripheral nerve and a series of peripheral nerve lesions have been immunostained with three different anti-epithelial membrane antigen (EMA) monoclonal antibodies. Sites of EMA immunoreactivity have been confirmed within perineurial cells of peripheral nerve, noted within the capsule of Schwannomas and palisaded encapsulated neuromas, and also detected with traumatic neuromas and plexiform neurofibromas. No expression was detected within simple neurofibromas, diffuse neurofibromas or within malignant Schwannomas. These sites of EMA expression concur with the suggested involvement of perineurial cells in the formation of the particular lesions. The relationship between EMA expression by the perineurium and the piaarachnoid membrane is discussed.     

IgM cryoglobulin deposits in the peripheral nerve

Summary In a patient with Waldenström's macroglobulinaemia and peripheral neuropathy, direct immunofluorescence of a peripheral nerve revealed the presence of abundant IgM and kappa light chain deposits in the endoneurium. Electron microscopic examination showed the microtubular structure of these endoneurial deposits, which strongly suggested the presence of cryoglobulin; this was then found in the serum.     

虚拟现实在糖尿病外周血管介入手术教学中的应用

糖尿病患者下肢远端血管易发生肌性动脉粥样硬化,形成动脉瘤、血栓等病理变化,导致血管阻塞或狭窄。如果侧枝循环也同时受到影响,很容易发生肢体缺血,出现问歇性跛行,甚至导致残疾等严重后果。但由于手术技巧要求高,且每个进修医生的操作机会有限,因此,我们将虚拟现实技术用于模拟介入手术教学,以提高培训效果,帮助进修医生尽快掌握介入手术操作的基本技巧。     

Autoimmune responses in peripheral nerve

Conclusions The PNS is an immunocompetent organ. The participating cellular and humoral elements in the local immune circuitry have been identified. A number of acute and chronic neuropathies appear to result from disturbed immune homeostasis. The model disorder EAN has been useful in examining the induction, amplification and effector phase of autoimmune responses to peripheral nerve antigens. Potential autoantigens contained in the myelin sheath and on the axolemma have been characterized. Thus, the recent years have seen a rapid growth of information concerning the pathogenesis of the important group of immune-mediated neuropathies. It can be anticipated that the better understanding of the principal mechanisms of autoimmunity in the PNS will aid in the development of more specific and efficacious treatments for these crippling diseases.